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Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.

HENDERSON VICTOR WIJAYA, PA-C

Active Sole Proprietor

HENDERSON VICTOR WIJAYA, PA-C is a Medical Physician Assistant healthcare provider located in FORT DRUM, New York. NPI 1326418823 is currently active in the NPPES registry. Verify at CMS.

Medical Physician Assistant · FORT DRUM, NY

Registration Details

NPI Number
1326418823
Provider Type
Individual
Gender
Male
NPI Issued
Sep 28, 2015 (10.902763351078 yrs)
Last Updated
Sep 30, 2023
Licenses
1178843
028353 (NY)
Sole Proprietor
Yes

Practice Information

Address
111050 MOUNT BELVEDERE BLVD
FORT DRUM, NY, 13602
Browse NY providers · Browse ZIP 13602
Phone
3157726976
Primary Specialty
Medical Physician Assistant
363AM0700X
Additional Specialty
Physician Assistant
Additional Specialty
Medical Physician Assistant

Other Medical Physician Assistant Providers in FORT DRUM, NY

Name Credential NPI
JEFFREY GLEN HART PA-C 1396728846
MR. PETER VERNON GOETCHIUS PHYSICIAN ASSISTANT 1285610451
MR. GEORGE JOSEPH DEVITA PA-C 1104803964
JEANNE YEAGLE P.A. 1902883564
MR. GREGORY JOHN PATAKY APA-C 1821076324
MS. TANYA MONIQUE PEREZ PA 1881672350
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.